Wednesday, March 18, 2015

Chemotherapy and Gay Sex Summary

When I started on chemotherapy over a year ago, one of the first questions and concerns I had was how this was going to affect my sex life. Would it chemically neuter me? Would it squash desire and/or arousal? Would I have to give up sex entirely or would I be too sick to care? These and other question worried me greatly.

The rest of this post may not be appropriate for all readers as it deals with sexual topics in a frank way. I would give it a “R” rating for language and sexual content.


Six years previously, my sex live was drastically altered when I had surgery for colorectal cancer. I was diagnosed with Stage I cancer of the rectum. Rather than living with a colostomy bag, a common treatment outcome, the surgeon removed my rectum and pulled my large intestine down and attached it to my anus.  By outwardly appearances I looked and functioned normally. The reality was every time my digestive system was stimulated, usually around food or drink, I would have to poop. I was now going to the bathroom (pooping) more than a dozen times a day usually around meals. Fortunately, the surgery had no complications that impinged on my sexual responses. But where it did have a huge impact was I could no longer sexually bottom or be the receptive one sexually, a position I especially enjoyed. This forced us as a couple to adjust our sexual patterns.

Five years later the cancer returns not to my colon but instead moves to my lungs. The chemotherapy treatments were now going to challenge us again on many levels including sexually. The question about having sex while going through chemotherapy is an interesting one. It is hard to get suitable information. Cancer and sexuality are a relatively taboo subject. Anything that comes close to the topic is on chemo and fertility...they don't mix because of possible birth defects. We asked several doctors explicit questions about what sexual activities are safe for us during the chemo cycle. How safe is it for me to engage in oral and anal sexual activities as both an active and passive participant? They agree that there is little medical info available.

Here's what we've been told:
My first chemo regiment (Oxaliplatin, Leucovorin, Avastin and Fluorouracil (5-FU) ) was on a 2-week cycle. 3 days of chemo drugs, 11 days off, repeat for 6 months. During the first 5 days of this cycle my body is excreting toxic chemo drugs through urine, feces, saliva, and semen. During this time, I should avoid kissing and having an orgasm on/in others. It’s ok for me to be the active partner in oral and anal activities. (Unfortunately, I no longer can bottom because of the colorectal surgery. I have no rectum and no sufficient space for penetration.) The remainder of my cycle is ok for kissing, receiving oral and being an active top. Fortunately, my chemotherapy hasn't diminished my libido like it can for some. But it has pretty much limited sexual play to every other week. We try to make the most of it when we can.

I am now on my second year and a new chemotherapy treatment with a fairly new drug. The first chemo regiment has left me with serious peripheral neuropathy (numbness) issues in my hands and feet. I am now taking Panitumumab/Vectibix, a monoclonal antibody, which works by slowing or stopping the growth of cancer cells. Same sexual cautions still apply. The unfortunate side effect I am currently dealing with is a major acne-type rash all over my head and upper torso. It gives me the appearance of having measles or chickenpox. Fortunately it doesn’t itch but it is a total intimacy killer. No one wants to have sex with someone who looks contagious or ill even if they are not.

Quoted below are several online articles I also found on this topic. The first is from a Dan Savage column that addresses a similar situation for a straight couple:
http://www.thestranger.com/seattle/SavageLove?oid=14714
On May 2 I was diagnosed with Hodgkin's lymphoma. While I won't bore you with all the details, I hope you can be of help in one area of my recovery (I have talked to four oncologists and have been too timid to ask this question). Can my wife perform oral sex on me and complete the act while I am on chemo? We have read that intercourse should be attempted only while using condoms, but no one mentions the good old-fashioned all-American blowjob. Can you help us find the answer?
Depressed and Slack-Jawed
My first impulse was to urge your primary caregiver to give you as many morale-boosting blowjobs as she possibly could. Thank God I called Dr. Barak Gaster, Savage Love's resident medical consultant, before I shot off my mouth. 
"Chemotherapy drugs are toxic," said Barak. "It's hard to find medicine that kills cancer cells but isn't damaging to healthy cells also. Although the amount of chemo that's present in semen is likely very small, the risk is probably not worth it--and it's definitely not worth it if there's any chance that the person on the receiving end may be pregnant (these drugs cause severe birth defects). The risk could be lowered a bit if she's careful not to swallow, but the risk is still probably not worth it." 
But do not despair! Get your dick good and wet before you put on a condom that's a size or two too big, and there will be enough play between the skin on your dick and the wet latex to provide you with the necessary friction. Trust me: You can get head and get off wearing a condom--I've done it in pursuit of safe sex, and you can do it in pursuit of chemo sex.

Additional resources about cancer, chemo, and sex that I found in various online support groups.
http://www.cancerworld.org/Articles/Issues/57/November-December-2013/e-Grand-Round/629/Managing-the-sexual-consequences-of-cancer-and-its-treatment.html
Managing the sexual consequences of cancer and its treatment
Cancer and sex: myth or reality?
There are lots of myths that seem to surround cancer and sexual activity. These myths are often not volunteered and may need to be skillfully brought into the conversation to normalize their existence in order to correct misconceptions. A common myth is the fear of contamination from radioactivity. Patients who have had pelvic radiotherapy may worry that they can pass radiation on to their partners. But there is no possibility of patients treated with external beam radiotherapy passing on radioactivity. The only situation where you would recommend avoiding sexual contact would be in a patient treated with sealed or unsealed sources such as iodine-131 who may still be considered radioactive.  
Some patients worry about cytotoxic contamination of their partner. There is a theoretical fear about being contaminated by the breakdown products of chemotherapy agents, but there is no research to indicate that this has ever happened, and I’ve never come across male or female patients whose partners developed irritation or difficulty associated with sexual contact. Patients who are very nervous about this might be advised to use a barrier contraceptive, but there is no theoretical or research evidence to back up this advice.
Some patients worry about whether their cancer can be passed on to their partner and can be reassured that this is not possible. Patients on treatment to suppress hormone levels, such as in prostate or breast cancer, can worry that having sex might lead to a surge in oestrogen or testosterone levels, but there is no evidence to suggest that this happens so we advise that sexual activity is perfectly safe. 
A more common fear is that sex might cause pain or damage. Patients can be reassured that it’s quite safe to have gentle sex during or after treatment for cancer. Some patients worry that sexual contact in the past has caused their cancer. For human papillomavirus associated cancers, it is helpful to explain that most sexually active adults are exposed to HPV, but not all of them contract a cancer that is associated with that exposure. For HIV-related cancers, advice should include safe sex messages with the use of appropriate barrier contraceptive methods to reduce the likelihood of HIV transmission.  
Some patients worry about being re-infected after successful treatment for a virally associated cancer if they believe their partner is the source of the virus. This often requires a conversation between the patient, their treatment team (maybe with advice from a virologist) and a sexual counselor, to work through the period of fear or anxiety.
http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffectsinmen/sexualityfortheman/sexuality-for-men-with-cancer-erections-and-chemo

How chemotherapy can affect erections
Most men getting chemotherapy (often called chemo) still have normal erections. But a few do develop problems. Erections and sexual desire often decrease right after getting chemo but return in a week or so. 
Chemo can sometimes affect sexual desire and erections by slowing testosterone output. Some of the medicines used to prevent nausea during chemo can also upset a man’s hormone balance. But hormone levels should return to normal after treatments end. 
A few cancer treatment drugs like cisplatinum, vincristine, bortezomib, and thalidomide can cause lifelong damage to parts of the nervous system, usually the small nerves of the hands and feet. (This damage may be called peripheral neuropathy.) For now, there are no studies showing that these drugs directly injure the large nerve bundles that allow erection. But some people have concerns because the drugs are known to affect nerve tissue, and there are many nerves involved in sexual function. 
Chemo can also cause a flare-up of genital herpes or genital wart infections if a man has had them in the past. Some types of chemo can cause short-term and life-long infertility. (See the “How cancer treatment can affect fertility” section.)

http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/chemotherapy/sex/sex-and-chemotherapy-for-men
The effects of chemo on men’s sex lives
Chemotherapy doesn’t usually have a permanent effect on your sex life. Some men lead normal sex lives during treatment. Others find that their sex lives change while they are having treatment, but go back to normal once their chemotherapy treatment has finished.
General side effects of chemotherapy include tiredness (fatigue) and feeling sick (nausea). These changes can make you feel less interested in sex during your treatment and for a while afterwards. 
More rarely, chemotherapy can make a man’s testosterone levels drop. Testosterone is the male sex hormone. Or chemotherapy can affect the nerves that control erections. So some men find that while they’re having treatment, they lose interest in sex 
Have trouble getting, and keeping, an erection
These changes are usually temporary and don’t last more than a couple of weeks after the treatment has finished. 
The emotional effects of having cancer can affect your sex life, too. Some men feel differently about themselves. You may worry about your ability to have sex, or about your ability to father children (fertility). These worries and fears can also lower your desire and your ability to have an erection. 
High dose treatment
Higher doses of chemotherapy are more likely to affect your sex life. You may have high dose chemotherapy with a stem cell or bone marrow transplant. Many people who have this treatment have radiotherapy as well. This combination of treatments is more likely to make you lose your sex drive or have erection problems during treatment and for a while afterwards. Research shows that high dose treatment temporarily reduces the levels of testosterone in some men. 
Who can help
It can be difficult to talk about your sex life, especially if you are worried or embarrassed. But do try to talk to your doctor or clinical nurse specialist if you’re having problems. Most of these side effects are temporary, but treatments are available. These include hormone replacement and drugs to help you get and maintain an erection. There is more information in the sex, sexuality and cancer section. 
Contraception
Always use reliable contraception during your treatment. It is not advisable for your partner to become pregnant, as the treatment drugs could harm the baby.
Even if your partner is taking the contraceptive pill, you should use barrier contraception (condoms) as an extra safeguard. 
Using condoms also protects your partner from the possible risk that chemicals from the chemotherapy drugs could be in your semen. Doctors don’t think that this usually happens, but it has been suggested that chemotherapy can get into vaginal fluids. As the doctors don’t know for sure, they advise using barrier contraception (condom) during a course of chemotherapy treatment and for a week or so afterwards.

AND finally from another blogger:
http://www.jlake.com/home/index-to-cancer-blogging/sex-on-chemo-a-users-guide-to-cancer-and-your-love-life/
Chemo is also like the world’s worst STD. Not that you can get cancer from a sex partner experiencing chemotherapy. But rather, any bodily emissions are considered cytotoxic, systemically toxic, and possibly caustic, due to both the primary pharmaceutical load and the drug breakdown by-products. Oncologists are deeply paranoid about the possibility of chemo pregnancy. (Think Thalidomide.) As a result, they generally counsel absolute abstemption from sex, without acknowledging outercourse or any other aspects of nonprocreative sex such as older age, infertility or nonheteronormative lifestyles. For liability purposes, any endorsement of sexual behavior of any kind opens the door to a pregnancy-related lawsuit against the doctor and their institution. Also in my experience, as well as reported by other cancer patients, oncologists really don’t like to talk about sex. 
So basically, a person on chemo is the Toxic Avenger brought to life. In addition to issues of ejaculate and even male pre-come, this includes urine, feces, sweat, saliva, blood, bile, etc. Literally any body fluid. I am advised, for example, to flush twice any time I use a toilet, and not to tongue kiss. At the same time, due to my being immunocompromised, I am forbidden from performing cunnilingus or analingus because of the realities of bacterial transmission. 
This pretty much leaves me with the options of shared/parallel, mutual or assisted masturbation, along with finger-to-skin, and mouth-to-skin contact (on my part) outside of the oral and genital areas. On chemo, the ED is so profound that even hand jobs from a sex partner are rarely particularly effective. Fellatio is still pleasurable, but should be carefully indulged in due to the possibility of sudden ejaculation. However, I can, for example, still suckle at a lover’s breast.

Disclaimer: I am not a doctor or trained in the medical field.  Always talk and check with your doctor before starting a new course of action. All information presented on this website should be regarded as friendly advice and opinions based on my experience and research. This information is for educational purposes and should not be interpreted as medical advice. 

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